Honors Program Completion Form

Students expecting to fulfill Honors Program requirements AND transfer the following semester must complete and file this form with the Honors Program Office. File dates are as follows:

  • Monday, December 5, 2016, if transfer is planned for Spring (January) 2017
  • Friday, February 17, 2017, if seeking TAP (UCLA) certification and transfer is planned for Fall (September) 2017
  • Thursday, April13, 2017, if transfer is planned (for any school except UCLA) for Fall (September) 2017

Failure to file may delay receipt of the Honors Program Graduate Award and transcript recognition of Honors Program completion.

______

Print last name First Middle

Student ID______Homephone______Cell phone ______

Email address:______

Street Address:______City______Zipcode______

Expected date of Transfer (Circle one): SPRING (Jan) 2017 FALL (Sept) 2017

TransferUniversity (1st choice):______; (2nd Choice)______

Pre-Major: (1st choice)______: (2nd Choice)______

Please list the Honors courses you have completed and those you are currently enrolled in:

Honors Course Title and Number / Check if
Completed / Check if
In Progress / Grade / # of units

Is your record of extracurricular activities up to date and on file? YES NO

>CompletedExtracurricular Event forms are DUE byApril 14, 2016

Have you met with a Counselor? YES NO

>Submit arecord of counselor meetings to date on required Personal Record of Counselor Visits Formand attach a copy when submitting Honors Program Completion Form.

Is your Personal Record of Counselor Visits Form up to date? YES NO

Completed original form is due in this office by April 13, 2017.

OVER

Check below dates of any meetings or activities of the HONORS CLUB (the club meets the monthly in HSS 223; dates vary depending on the semester) that you have attended this 2016-2017 academic year?

___9/2016 ___10/2016 ___11/2016 ___2/2017 ___3/2017 ___4/2017

List the Honors Club activities you have participated in during Fall2015 or Spring 2016 semesters:

Project/Paper Presentations:

What was the total number of Honors papers/projects did you formally present before your peers? ______

Date(s) of presentation:______Not yet presented ______

Did (will) you present (please check below)

______in class (Please specify class(es) and the instructor(s) name)______

______

______at a conference (Name of conference:______)

______at Moorpark College Student Symposium/Poster Session

Please indicate the title of your project/presentation(s)______

Graduation:

Are you earning an AA-T or AS-T degree from Moorpark College?

______Yes ______No

Transferring students may participate in Moorpark College graduation ceremony. We strongly encourage your participation, as you will be recognized as an Honors Program graduate. Are you interested in participating?

______Yes ______No

Do you plan to participate in the Moorpark College Honors Program Awards Ceremony in May?

______Yes ______No

Scholarships:

Have you been awarded any scholarships while attending Moorpark College? If yes, please name them?

Are you interested in applying for any scholarships?

______Yes ______No

______

Signature Date

Please return to the Honors Program Office/Social Science Division Office, HSS 217, OR

Cynthia Barnett, HSS 216, or mail to

C Barnett

Moorpark College

7075 Campus Road

Moorpark, CA 93021